A lot of media attention, including television, print, and online sources, is focused on various plans to revolutionize the delivery of health care in America. Critics point to medical errors, waste of resources, and lack of access among the numerous factors requiring the replacement of our health care system. To many politicians and think tank experts, the combination of government support programs (including Medicare, Medicaid, and Social Security disability) plus private group and commercial health insurance plans no longer meet the needs of the people. These proposed replacement systems, which are estimated to cost trillions of dollars, would further undermine the relationships doctors have with their patients due to the heavy hand of government. Furthermore, none of the proposed delivery solutions speaks to the disturbing trend of physician burnout and the associated physician shortage that the country will face in the future. Currently, these parallel lines of policy do not intersect, and physicians are feeling the stress of uncertainty regarding their roles in an ever-changing health care landscape.
In addition to their primary role as healers, doctors are now expected to be data entry experts. Their work product and reimbursement are justified by the diagnostic and procedure codes documented in the medical record. The requirement for documentation shortens the time doctors spend with each patient, and the requisite computer entries seem to take precedence over patient care. The result is a growing dissatisfaction with the practice of medicine and feelings of depersonalization.
Physician depression and suicide are now major topics of investigation and comment in professional journals, yet the notion of parallel thinking on the subject of physician well being has become apparent. One school of thought believes that the doctor needs to become more reflective and resilient in the practice of modern medicine. According to this school, the system in which the physician works and lives must provide the tools (e.g., yoga and discussion groups) to help strike a balance between the commitments of professional and personal time. An opposing view looks at the world in which doctors are educated and employed as adversarial, decrying the violation of doctors’ human rights due to sleep deprivation, harassment, and irregular breaks from work. Such a system, according to some physician advocates, blames the victims for the abuses it heaps upon doctors. When doctors feel there is nowhere to turn for help, they become depressed, some to the point of suicide.
The struggle to define a doctor’s role in health care policy and practice must find some accommodation between the demands of the established administrative hierarchy and the individual physician’s needs. Voices from each camp must be willing to listen and to engage each other in constructive dialogue. If the energy derived from opposing forces can be harnessed toward progress, a crisis in the delivery of health care may be averted. Let’s try synergistic thinking, rather than parallel thinking, to tackle problems in health care.
Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender.
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